Magnetic Resonance Imaging of Impending Left Ventricular Rupture After Acute Myocardial Infarction
A 63-year-old man with a history of arterial hypertension was admitted to the Cardiology Intensive Care Unit with an inferior acute myocardial infarction. The patient received 10+10 units of reteplase. Transthoracic echocardiogram showed an akinetic inferior wall and depressed systolic function (ejection fraction=40%). Cardiac MRI (Siemens Somaton Vision, 1.5 T) performed 4 days after the infarction for investigative purposes showed an infarct of the left ventricular inferior and posterior walls. The right ventricle was also partially involved. After gadolinium injection, a transmural serpiginous hypoenhancement signal was present in the infarcted area, consistent with myocardial hemorrhage and suggesting impending cardiac rupture (Figure 1). The patient suddenly died 5 hours after the MRI study. Autopsy showed an inferoposterior infarct involving the right ventricle. A myocardial rupture was present in the middle portion of the posterior wall corresponding to the hemorrhagic area detected by MRI (Figure 2). Histological examination showed myocardial necrosis and diffuse interstitial hemorrhage (Figure 3).
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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